Provider Demographics
NPI:1952677528
Name:SCARBROUGH, RACHAEL REED (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:REED
Last Name:SCARBROUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:RACHAEL
Other - Middle Name:ANEVA
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5109 NEWELL RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-1150
Mailing Address - Country:US
Mailing Address - Phone:601-482-7105
Mailing Address - Fax:
Practice Address - Street 1:1106 CENTRAL DR
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-8972
Practice Address - Country:US
Practice Address - Phone:601-656-1044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC10421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical